In October 2014, ISUOG Outreach supported a workshop in Darwin (Northern Territory), Australia, in partnership with the Australasian Society of Ultrasound in Medicine (ASUM) to improve maternal health in aboriginal communities. The workshop trained local general practitioners and midwives on basic ultrasound in obstetrics and gynecology to support their practice in the remote aboriginal communities of Northern Territory. The project was led by Nayana Parange, Sujatha Thomas, and Karen Shand who happily shared their experience in the interview below:
In a few words, tell us about the Outreach Workshop
The key purpose of the Outreach workshop was to provide ultrasound training to midwives and doctors working in the Northern Territory Outback regions to help their practices to meet the Australian national antenatal Care Guidelines. In doing so, we hope to support the development of a model for the training of health professionals in remote areas which would be relevant to the Australia, as well as to evaluate this model with regards to its suitability to be replicated in other regions across the country.
High-risk pregnancies are more prevalent in Aboriginal and Torres Strait Islander women that stretch the low-resourced community health centres. Due to a higher rate of preterm births and intrauterine growth restriction, predicting gestational age is particularly important so that these women can be referred to larger, better resourced centres for delivery. The high smoking rates, pre-existing medical conditions and socioeconomic disadvantages place additional burdens on these communities.
Training remote midwives and GP’s will enable them to deliver point-of care-services better, encouraging women to present early for a dating scan and antenatal booking. Families and partners would be able to attend this examination, improving bonding, positive family support and early health education. However, training and retention of the workforce in remote settings continues to be a challenge as midwives and GP’s relocate frequently to other isolated settings
What inspired you to bring ISUOG Outreach to Darwin?
The demographics of the region, as per the Aust Bureau of Statistics 2008, demonstrate that 54% of the population live in the town of Darwin, 14% live in Alice Springs and the remainderlive in the rural Northern Territory. A disproportionate number, 72%, of the aboriginal population live outside the two urban areas, in very remote communities. This has an adverse impact on health outcomes, at least partly as the most basic of services may not be available locally.
My involvement with the ISUOG Outreach training programmes overseas brought the realisation that we need to offer better ultrasound services amongst our own underserved communities. We thus sought the expertise of ISUOG, which was immediately forthcoming but as we also wanted to achieve a national standard for this training, we approached ASUM as well. We aimed to develop training and credentialing within a unified national framework encompassing these goals in a rural, remote and indigenous context. Recognising this need, ASUM also decided to introduce and implement a credentialing for midwives called the CAHPU (Certificate for Allied Health Performed Ultrasound (CAHPU) Midwife Specific) certification.
Dr Sujatha Thomas is an obstetrician in Darwin already involved in outreach work in obstetrics and was looking for ways to get better ultrasound services to remote areas, including achieving more accurate dating of pregnancies. Integrated Maternity Services from Northern Territory Health Darwin sought Sujatha’s support in identifying the appropriate training for midwives working in these areas. 20 midwives and 1 GP were selected to undergo training.
As ISUOG and ASUM had experience and resources to deliver training workshops, collaboration was formed in conjunction with the Northern Territory health services. Sujatha was then able to bring everyone together, including recruiting additional high calibre faculty such as Roger Weckert and Carol Brotherton – both senior tutor sonographers, Dr Russell Carter who is a procedural GP in obstetrics and Dr Martha Finn who is a senior obstetric and gynecological sonologist from Melbourne.
In addition to the support provided by Sonosite for portable machines, simulation vendors VIMEDIX and Synergies also generously offered use of their obstetric simulators for transabdominal and transvaginal training. This was very exciting for us, as we were able to incorporate simulator training along with hands-on training on real patients at the same time. We covered all the topics pertinent to basic level scanning in a ‘point of care’ situation.
A follow-up hands-on session has also been scheduled four months down the track, to reinforce the practical skills, review the performance and audit the images. This will give us a chance to establish where our training needs to head to achieve our aims.
Trainees diligently learning at the workshop
ISUOG Outreach Sujatha Thomas providing hands on training with live patient
Australia is classified as a developed nation. Do you therefore believe that ISUOG’s mission, to improve maternal mortality, is still relevant here and how do you think ISUOG Outreach, in particular, can help?
The issues in remote Australia are unique. The Northern Territory (NT) is Australia’s third largest state, with 243,000 people living in an area of around 1,346,200 km². If the NT was a country all on its own, it would be the world’s 20th biggest in terms of land mass, just ahead of Peru. The UK could fit into the NT around 5 1/2 times and it is almost twice the size of Texas.
Sixty percent of the NT population live in “very remote” areas, scattered in small communities over very large distances. These communities experience the lack of immediate access to health services and many communities do not have resident midwives or GP’s or these services are only accessible by air. During the wet season the small airstrips may be flooded resulting in even greater isolation.
Women in remote regions are not able to access ultrasound examination in early pregnancy due to patient travel funding limitations, limited availability of adequate equipment, and lack of ultrasound training of local health professionals. Retention of the workforce continues to be a challenge and those that fly in are required to provide not only obstetric services but a broad range of medical care over all specialties.
These challenges represent only the tip of the iceberg. There are so many other complexities including socioeconomic, inadequate education, language barriers, racial prejudices, high risk and health related behaviours which contribute to the wide gap between Aboriginal health and the rest of Australia. Although Australia is a first world country, these challenges can be third world or even fourth world in some instances.
We believe that the ISUOG mission is therefore still relevant even in Australia, and our pilot endeavour has made an attempt to take a step forward in this direction, in terms of obstetric ultrasound services. We are very thankful to ISUOG, as it has generously assisted in addressing this aim to “Bridge the Gap” by sharing the existing training course material and their assistance in “tweaking” the training will be invaluable as it becomes clearer as to what we can expect to achieve successfully within our own rural and remote context here in Australia.
Trainee using her skills on the field within the aboriginal communities
How has being a volunteer with ISUOG supported your desire to make a difference?
I have worked as an obstetrician-gynaecologist and a sonologist in a rural community in India for nearly 10 years. I am familiar with the problems faced by developing countries and have been exposed to the different challenges one faces as a health professional working with limited resources. During my time in India, I conducted ultrasound training workshops in remote regions to help train GPs and specialists. This prompted me to become a volunteer with ISUOG Outreach once I had migrated to Australia. The experience with the ISUOG Outreach team in Ghana gave me the opportunity to work in a team with high a calibre international faculty who were passionate about making a difference, and also taught me the ‘train the trainer’ approach which ISUOG does so efficiently.
The ISUOG Outreach experience in Ghana inspired and motivated me to keep working towards improving perinatal mortality with the help of ultrasound. In addition to working towards our ‘Close the ultrasound gap’ initiative in Australia, I have, for the last three years, also been involved in similar ultrasound outreach initiatives in Papua New Guinea as well as the remote East coast of Indonesia. I am very fortunate to have wonderful colleagues like Karen and Sujatha as well as many other experienced and qualified professionals who share the passion and vision, eager to make a difference.
From left to right:
Roger Weckert (NT,Darwin), Clare Whitehead (NT, Darwin) , Russel Carter (NT, Darwin) , Karen Shand ( South Australia, Adelaide) , Sujatha Thomas (NT, Darwin), Nayana Parange (Adelaide, SA) Martha Finn (Victoria, Melbourne), Amanda Grauze (Simulator educator and Director Medical Synergies, WA)